Flashcards in Compartment Syndrome (Tabor) Deck (25)
Define compartment syndrome
life threatening and limb-threatening condition that results when perfusion pressure falls below tissue pressure in a close anatomical space
What are general causes of compartment syndrome
constriction (casts/tight ski boots/strangulation in neonates...)
internal increase in pressure (fracture, trauma, drugs, Ruptured Baker's cyst...)
What is the general pathogenesis of compartment syndrome?
Muscles and peripheral nerves intolerant to hypoxia. Hypoxia causes release of vasoactive/inflammatory substances (ex. serotonin)
Where does compartment syndrome occur?
anywhere in the body where skeletal muscle is surrounded by fascia and bone
Where is the most common location for compartment syndrome?
Anterior compartment of lower leg (80%)
A 28 year old male patient presents with a deep, throbbing, burning pain. He states that he feels pain at rest and with activity, as well as with stretching of the muscles. What could he have?
ACUTE compartment syndrome
give away: pain at REST and w/ activity
Decreases sensation of light tough and within the 1st web space of the feet can describe injury of what nerve? Which compartment is this related to?
Deep Peroneal N. in the Anterior lower leg compartment
If a patient presents with a tibia or fibula fracture, what nerve could this effect, and in which compartment would exhibit compartment syndrome?
Tibial Nerve in the Deep Posterior lower leg compartment
What are the 5 P's of diagnosing compartment syndrome?
If a patient only show 3 of the 5 P's for compartment syndrome, could they still be diagnosed for having compartment syndrome?
Yes; Not all symptoms need to be present for diagnosis, but if you have all of them, you DEFINITELY have compartment syndrome
What is the gold standard for compartment syndrome diagnosis?
Compartment pressure testing
What is the definition of Chronic Extertional compartment syndrome (CECS)
- Overuse injury affecting young endurance athletes
- Results from increased pressure in osteofascial planes
- Predominantly in LOWER leg
- Lack of compliance of fascia increases compartment pressure due to expanding muscles
A 28 y/o runner wants to stop running and decides to fake having a lower extremity CECS, what symptoms should he fake?
-Gradual increase with pain several minutes after starting to run.
- Pain goes away after cessation of activity
- weakness or paresthesias
If you are thinking an 18 year old female runner has CECS, what diseases should you eliminate first?
- Medial tibial stress syndrome
- Stress reaction/fracture
- Deep vein thrombosis (DVT) ***
- Peripheral nerve entrapment
- Lumbar radiculopathy ***
- Tendinopathy ***
What is the gold standard to measure compartment pressure syndrome?
Measure compartment pressure directly.
How is CECS diagnosed?
- Patient performs exercise which reproduces symptoms
- Check each compartment 3x
At resting, what compartment pressure is necessary to diagnose CECS?
1 minute post-exercise, what is the minimum compartment pressure necessary to diagnose CECS?
5 minute post-exercise, what is the minimum compartment pressure necessary to diagnose CECS?
What are the two general treatments categories for CECS?
Conservative and surgical
What is the most common surgical treatment for CECS?
What are the contraindications of fasciotomy for CECS?
after 4 days of symptoms
What is considered Conservative Treatment for CECS?
Modification of exercise
What is normal compartment pressure?